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Illinois rates for MS-DRG 904

Skin grafts for injuries w CC/MCC

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33,700.69 / $45,785.20 / $64,316.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25,082.99 / $40,645.41 / $57,853.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29,399.49 / $41,237.89 / $73,462.00
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$220.39 / $418.99 / $686.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32,382.05 / $44,815.49 / $73,755.85